title: Success of uterus-preserving treatments for abnormal uterine bleeding, chronic pelvic pain, and symptomatic fibroids: age and bridges to menopause.
abstract: OBJECTIVE
  The purpose of this study was to determine whether age at first uterus-preserving treatment (UPT) predicts symptom resolution among women with common pelvic problems.
  
  
  METHODS
  We conducted an analysis of 557 participants in the Study of Pelvic Problems, Hysterectomy and Intervention Alternatives cohort who reported having undergone a UPT. We performed multivariable regression modeling age at first UPT, hysterectomy, menopause, and other covariates to predict symptom resolution.
  
  
  RESULTS
  Mean ± SD age at enrollment was 42.7 ± 4.7 years; mean follow-up time was 4.4 ± 2.7 years. Sixteen percent of the women underwent hysterectomy; 37% of the women entered menopause. Hysterectomy was a strong predictor of symptom resolution (P < .001). Compared with women who were younger (first UPT at age <40 years), older women reported greater symptom resolution, even after the data were controlled for hysterectomy use and menopausal status (P = .028).
  
  
  CONCLUSIONS
  Women who are ≥40 years old when they undergo their first uterus-preserving treatment experience greater symptom resolution than younger women. Framing UPTs as hysterectomy alternatives may be accurate only for a subset of women who are >40 years old.
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. llearman@iupui.edu
authors.forename: Lee A
authors.initials: LA
authors.lastname: Learman
authors.forename: Sanae
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gregorich
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Jackson
authors.forename: Alison
authors.initials: A
authors.lastname: Jacoby
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
mesh_terms: D000328:Adult; D000367:Age Factors; D002908:Chronic Disease; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000601:surgery*; D008593:Menopause; D008875:Middle Aged; D017699:Pelvic Pain / Q000601:surgery*; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery*; D014599:Uterus / Q000601:surgery*